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The People Medicine Neglects

Op-Med is a collection of original articles contributed by Doximity members.
Illustration by April Brust

In Mississippi, there is a tendency to see things in black and white — literally. There are so many other demographics of people who were here both long before and after the first white “settlers” developed “economy” based on the exploitation of slave-labor for a newly booming cotton industry. The Native people of this beautiful terrain, the Choctaw, Chickasaw, and other nations, are often left out of the narrative when it comes to both culture and healthcare. Therefore, a group of underrepresented medical students, including myself, made it a priority to host healthcare outreach efforts targeting minority communities, especially Native populations of Mississippi.

This has become an annual journey, begun our first-year of medical training. Our first summer, we caravanned to the reservation, which is about two hours from our medical center. Healthcare screening bags and barely used white coats in tow, we pulled up to the reservation with an idealistic image of how this first screening event would go; we had tiny cards to document individualized blood pressure, blood glucose, BMI, and other health advice, so the people we screened could take this information to their Primary Care Physician (PCP) and be their own advocates for lifestyle modifications. However, what we saw was that there were more social determinants than we could have prepared for — much of it not by their own design.

Within my institution, there is a common saying that, as medical students (or maybe even residents and attendings), we can feel more like social workers than physicians at times; however, sometimes that is what it takes to get our patients the long-term care they deserve. The day of our first healthcare screening event, we had patients who had not had their diabetes medication for weeks to months and who had never visited a PCP, despite the fact that the reservation recently built a new health facility, because of external factors within their lives. These are not problems specific only to the Native population, but it was when I was working on the reservation that I had the realization that there are more efforts to educate, inform, and take action on these issues in rural white and black areas of Mississippi than in an area where the real founders of our state originated.

I heard multiple stories demonstrating the fact that “access to healthcare” is easier said than done. Native American gaming consists of casinos and other gambling operations on Native reservations or other tribal lands throughout the United States. This system has been monetarily rewarding, bringing in $27 billion as of 2011 to around 240 tribes in this nation. However, like any major movement within history, not all was good for everyone within vicinity of this societal change. Not all Native people have struck it rich with these establishments. Furthermore, people affiliated with this industry all have different experiences. I met one man at our healthcare screening — more than eager to be active in getting healthcare that day, even if it was just a blood glucose number. After getting a markedly increased number and questioning him about his eating for the day (postprandial vs. fasting), he stated he knew he was a diabetic and was already on medication. However, his job at the casino prevented him from getting to his PCP or pharmacy to refill his diabetes medication. As a team of medical students, we tried and tried to come up with a plan of action for him to get the treatment he needed, but as a student, there is only so much you can do.

Fast forward to my third-year of medical education — bright-eyed and bushy-tailed. Internal Medicine rolls around, a rotation many students see synonymously with the television show House. After figuring out the EMR for the medical center after being on my Family Medicine preceptorship at an off-site clinic, I looked up my first patient’s chart. “Interesting, this name sounds familiar.” I walk into the room and saw a patient I had screened on the reservation. She looked nothing as I remembered her last.

I walked into my patient’s room, and we immediately began talking about people we both knew, how her family was unable to make the trip to the hospital that night, and how proud she was of her nephew. As we conversed, I tried to think of her numbers at the screening event but could not recall and asked her if she ever followed up with her PCP. She continued talking about everything but her PCP — a sure indicator that no, she probably had not. I looked at her legs; they were leathery, I could barely feel her dorsal pedis pulses, and the skin looked more grey-black than the beautiful caramel-tone I remembered. I continued with my formal H&P, knowing I had only minutes before my first rounding experience with my new team.

Post-rounds, I returned to my new friend’s room and asked her what would make this stay more tolerable and even enjoyable. “Well, I love reading, and I love cooking even more.” That, I could do something with; I called my father who lived about an hour away — notorious for his interest in herbal medicine and asked if he had any cooking books lying around. Within an hour, I had three books for my friend, who was more than excited to have something to do besides watching, as she said, “politicians who have no interest in making the lives of my people better.” For the next five days, she read every page of those books and vowed to make numerous recipes and even eat healthier once she returned home.

I am now towards the end of my third-year and wonder where my friend is now. We said our goodbyes on my last day of my first rotation, and by that time, her labs and clinical presentation were not within normal limits at all. I followed her chart to the OR room for surgery, saw that she was discharged, and continued to my next rotation, wishing I would run into her anywhere else but the hospital. I hope my friend is living the life she deserves.

Identifying characteristics have been changed for identification/privacy purposes.

Denise Powell is a medical student currently interning at the ABC NEWS Medical Unit. In her spare time, she enjoys traveling, hidden music venues, and finding ways to contribute to underserved and underrepresented communities.

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